Abstract 11790: New and Old Cardiovascular Disease Risk Models to Predict Events in HIV Infected Patients
Background: The high incidence of cardiovascular events in HIV infected patients creates the important challenge of performing an accurate risk assessment and initiating treatment in the most appropriate patients. The new Pooled Equations (PE) recommended by the recent ACC/AHA guidelines have not been tested in HIV infected patients and compared with the older Framingham Risk Score (FRS).
Method: Cohort of 2,550 HIV infected patients (34% women) followed prospectively for a total of 10,695 patient-years. We compared the 10-year risk of events of 7.5% with PE versus a FRS level of 6%, for the dual purpose of assessing the validity of the new algorithm in HIV and verify whether lowering the threshold of the older algorithm may be equivalent to the new method.
Results: Mean age was 49.7+/-7 years, and mean HIV exposure was 16.6+/-6 years. Total follow-up was 10,695 patient-years and 67 non-fatal myocardial infarctions and 2 CV deaths were recorded. PE>7.5% and FRS>6% predicted (44/69 and 49/69) and missed (25/69 and 20/69) the same number of true events. The Net Reclassification Index showed that PE>7.5% is weaker than FRS>6% to predict events (7% fewer events predicted) but better to predict non-events (14% more cases predicted to not occur). Table 1 shows the recommendation for statin therapy according to PE and FRS compared to current clinical practice within our institution: the 2 algorithms were not superior to what is currently implemented at our institution.
Conclusions: In HIV infected patients the new PE>7.5% algorithm performs similarly to a FRS>6% to predict events but is better than the older algorithm to predict non-events. Neither model is superior to clinical practice as a method to select patients who should receive risk reduction therapies. (p-value for comparison of recommended vs actual statin prescription)
Author Disclosures: P. Raggi: None. D. De Francesco: None. S. Zona: None. C. Stentarelli: None. F. Carli: None. A. Malagoli: None. M. Maniscardi: None. A. Bellasi: None. G. Guaraldi: None.
- © 2015 by American Heart Association, Inc.